Update - Malaysia Placement

I have now paid my deposit and all has been confirmed for me to jetset to Malaysia late September. Although still 3 months away, I am getting excited about the thought of doing something that is completely unlike me in the sense that I am homebody, a bit of loner and hate being away from my family.

I still haven't yet received my itinerary but we have been advised to organise our passports, immunisations and learn some of the native language. All a bit exciting!

I am hoping to get more info in weeks to come so stay tuned!

Jampa lagi!!

Time stood still...

Yesterday was one of those days that you look back on and question whether you did everything you possibly could given the situation. So much so, that you go to bed thinking about it, dreaming about it and the next day it begins to crash down like a ton of bricks.

The morning went smoothly as I attended a Caesarean Section. I was nervous going into it because the woman had had a previous emergency and had ended up with a cerebral aneurysm and impaired sight due to the effects of the anaesthesia and a postpatrtum haemorrhage which unfortunately I am getting used to. Thankfully all went well both for mother and baby. I spent a lot of time with her postoperatively and I lost count of how many times that she asked 'why do people opt for this?' or 'why would anyone want to put themselves through this if they didn't have to?' I am not entirely sure myself.

After this I was given the opportunity to care for another woman in labour, all was going well throughout the morning. Another induction but progress was being made. As always, there was the generalised attitude that multip=quick labour and despite a dilation of only 4cm in about 6 hours, amazingly everyone was pretty happy to let things go (Hallelujah!)

Things progressed well and next thing second stage had begun and we had baby's head on view. Again it wasn't as normal for a multip as the head took a long time to manoevure the Curve of Caris and crown but it happened just the same. It was beautiful to watch the woman instinctively work through it.

Time stood still and I awaited restitution... nothing. Contraction and nothing. The head slid back after I caught a glimpse of a cord and it was freakishly tight. Midwife made the call to cut and I made the call that we had a shoulder dystocia.

It took two to at the receiving end, two on either side trying McRoberts and me climbing onto the bed to begin with suprapubic pressure. All hope seemed lost until I felt the shoulder and manage to flick it around the symphysis pubis.

I don't think it really hit me what had happened until the midwife I was working with burst into tears. I am just glad I knew what to do at the time. Even more, of those midwives I have spoken to, many of them have gone years or decades without ever experiencing this or the extreme of PPH's and here is me, not even a registered midwife and I have been a part of both. I am taking it as a positive in the sense that experience equals knowledge and knowledge of what to do in situations like yesterday could mean everything.

More equations that don't add up

Having a day off, I took myself out with the kids to do some shopping and have my coffee fix and found myself thinking about what I wrote earlier. Talk about living and breathing birth! Following on from my last post...

I made the statement that most primips, if left to gestate, will go beyond their due date. I am not yet entirely sure of all the reasons as to why this happens but I have read in places that it may have something to do with their body not ever having done it before. Obviously there is controversy as to whether or not this is true as there are many multips that go above and beyond their due date too, me being one of them. But it got me thinking anyways...

If the current trend continues, primips who reach their due date will be offered induction of labour. With or without an ideal bishop score, ripe cervix, a baby ready, the cascade will be begin. Time constraints will then impose, that is 'by this time, this will happen and if that doesn't happen then we will do this and if that fails, then we will attempt this for x amount of hours'... in the meantime, baby gets upset, distressed or completely pissed off - answer is caesarean section. If baby is happy, we continue until such time as there is some issue such as 'obstructed labour' , 'cephalopelvic disproportion' or 'failure to progress' and find our way to theatre anyways.

Or maybe its a high head, OP position or deflexed vertex, and maybe the use of forceps or a ventouse will result most likely with an episiotomy. The incline of induction rates means a greater likelihood of deviations from the norm which is inevitably going to lead to either assisted births or sections, increasing the section rate even further.

So then these primips end up with a section and when their next pregnancy comes about, they have minimal options, elective section or (cough, cough) VBAC. VBAC is certainly an option but in a system that has 'ifs' and 'buts' attached to everything, whether it remains an option will be down to whoever the woman sees on the day.

Unfortunately this is becoming the reality and women, although having an option as to what they want to do, by majority, do not realise it or believe it. And more, most place their decisions in the hands of those that do not really care about the well being or future of the particular individual but rather the convenience of booking an induction or section. It has become too difficult to give the power back to the woman and if the woman does have the power, somehow the are tainted and labelled uncooperative or radical.

Looking at it from this angle it makes sense that things are heading the way they are. What I do not understand is why women are giving into it. I know that every individual is different and varies in ideals and preferences but why is it that so few really question or seek clarification and understanding?

So here I am wanting to give the power back to women. I am confronted with a woman who by her dates is only just 40 weeks, a scan at 20 weeks suggests her dates are wrong despite her certainty. Her EDD is adjusted to suit the scan because baby is 'BIG'. On assessment, she has a bishop score of 3, head still high but nevertheless, head down, but induction is commenced regardless. What do you know, nothing happens! Discussion is had, a decision is made - C-section. Reasoning - unfavourable cervix, failed IOL, high-head, post dates (despite her only being due today based on her dates) oh and dont forget the massive baby onboard (even though she is over 6 foot and appears to have decent pelvic space). She agrees without a second thought.

Given my situation and my current role, I debate as to whether I should speak up. I realise that if there was ever time to step in and advocate for a woman it is now and I go in with the attitude that I am informing her of all her options, not just the escape route. Despite what I know, I put myself in her position and know that if someone was hanging outside of my door with choice and options, Id want them to make it known.

And so I go to her and I open her up to the options and I feel like I have fulfilled my purpose as a midwife and everything that a midwife entails...

I get shot down and feel like I am an imposition, stepping on toes and completely out of place. I walk out feeling uncomfortable not because I feel like I have said the wrong thing but because I am lost as to the reasons why anyone would not want options and choice and rather leave it in the hands of those that ''know whats best!"

I did what I felt was right and despite it not having an impact at the time, I can only hope that one day she looks back and remembers that someone was willing to stand strong and uphold her rights and autonomy. I once thought that given the opportunity to do what I did and receive the response I got, Id feel lousy, yet I feel good knowing that at least she was aware that there was a choice regardless of whether she grabbed ahold of it or not.

And so I ponder the reasons why we have become mute as humans and lack the authority and the power to make decisions based on our own choices and beliefs allowing others to abuse us and decide what is ultimately our decision.

Any comments you have in response would be thankfully accepted.

Questioning the obvious and proposing the unlikely...

Despite getting used to the occurrence of getting to work and being made aware of the amount of inductions and caesarean sections, it still gets to me. I do understand that there is a time and place in which they are needed but shockingly, the facts that Michel Odent spoke of are becoming more real and evident. I have been reflecting and addressing my frustration over this and trying to formulate some plan to change this trend particularly as I am due to take the leap next year and finally drop that infamous word 'student' from my title.

I am aware of the mass opinion that I will be up against when I finally do become registered but I am hoping that I continue on the path I have laid and stand strong and make a difference. Obviously it will be a challenge given the politics and legalities of the system but given my incessant need and want to bring birth back to what it is or in todays culture, what it should be, I will fight until the bitter end.

I have grown complete and utter despise for induction and looking back on my own experience, think myself lucky that it went reasonably smoothly. Almost every induction that I seem to witness fails or causes complications that inevitably result in a section. I am close to summing it up in my head - induction = delayed c-section. I choose my words carefully because in the delay between induction and section comes intervention. I am trying to find the words to express what I am feeling in relation to the future of this rather bold and forthright equation because I am sure that amongst the mist and the clouds, there are many that are pushing for something along the lines of - induction = c-section or worse birth = c-section.

The worrying thing for me has been the encroaching nature of the beast on length of gestation. Once upon a time it seemed safe to leave a woman to bloom until 42 weeks. Four years ago, knowing very little and being as naive as I was, I had to beg the doctors to induce me at term + 12 days. They wrote on my notes - IOL for social reasons. Now compare this to what I am seeing today

• IOL from the EXPECTED due date
• Social induction from around 38 weeks
• Failed induction due to unripe cervix (GO FIGURE!!)
• Vernix covered babies at T+ gestation (hmmm)

And thats only the start of it. Although I do not like to generalise, it seems that by majority we have lost touch with our bodies and hence when pregnancy miraculously occurs, we have no idea when we conceived, when our last menstrual period was or even care. I can understand this because sometimes the last thing I want to think about is my period and how annoying it is but what I am trying to highlight is the fact that, our bodies, our cycles, our ability to produce life, sustain it and give birth to it have become second, third, fouth, etc, to higher priorities.

I am deliberately making this point to try and justify in my minds how there always appear to question marks near or around the estimated due date. Deliberately because I want to make the point that its only an ESTIMATE!!!! Normal pregnancy gestation is 37-42 weeks, look in any text or reference and this will be clearly written, yet somewhere and somehow someone decided that that wasn't good enough. We need routine, structure, a timetable!

As far as I can gather the EDC or EDD was only created to give them woman some insight as to when labour may start. I dont think it was ever meant to be THE be all and end all OR the determinant of what will or wont happen. So unfortunately this date has been manipulated in such a way that it warrants the rights of OTHERS to make a decision as to when a baby is born.

I sat up thinking about this last night with the knowledge that primips or first time mums in general will go into labour post their due date and wondered with the understanding that we have, that being that between 41-42 weeks gestation is still safe, what would happen if we shifted the EDD to equal a gestation of 41 weeks rather than 40? Come into play politics and legalities but all that aside, what would be the outcome particularly as I am aware that 40 weeks gestation is an average gestation.

Nothing much changes. There is still an EDD, there is still that date to linger on, there is still room for manipulation. The truth of the matter is, nothing in this world is set in stone, nothing is stagnant, things change. Given that as humans we manipulate and influence so much, how can we be sure that we haven't done the same on the normal gestation of pregnancy? Its obvious we have had an enormous influence on it in a surgical, medical way but I am talking more of the physiological, psychological and environmental way. If the human race has the ability to F*#$ the planet as it has and influence global warming, seasonal shift, pump hormones into the food we consume, control life as far as messing with genes and cellular bits and pieces and possibly initiate many of the natural disasters that have occured in recent years (or months!), whats to say that we haven't done the same to pregnancy, the initiation of labour, a babies' birth??

Food for thought and my need to question...

Birth, Breastfeeding and Beyond Conference

Despite it taking me almost a week to write about it, I haven't forgotten the truly inspirational stuff that I heard whilst listening to Michel Odent and the other speakers of this conference. After debating for so long as to whether or not I should go, I am glad that I made the decision to take the day off of placement and spend a little bit of money on an emotional, uplifting and motivational experience.

I knew of Michel Odent and his work but have never really had the time to sit and read his books and adding to my library has come to a halt with the amount I outlay in textbooks, travelling and uni related stuff. However, I couldn't deny myself the opportunity to meet the man himself and have him sign one of his works for me as a reminder of what my role is within the current birthing culture. And so I bought 'Birth Reborn' and have begun to read it in the very few spare moments I have. I am sure that it will initiate many posts at a later date, so stay tuned.

It was just surreal to hear him talk. Intitally I found his accent quite hard to understand but once I became so engrossed in what he had to say, I was in the zone and despite sitting in the back row, felt like I had connected with his insight into birth and breastfeeding. On a professional level it linked and correlated so much of what we know to be true in a very different way but for myself, as a mother and a soon to be midwife, it struck something else in me. His words gave meaning and justification to the love that I feel for my sons and how important their transition into this world was, not just for me or their father but for all those they will come into contact with during their lives. It was so simple an explanation of how life and love come together and yet despite its simplicity, few of us in our normal, everyday life acknowledge it.

I walked away at the end of the day wondering if the world would change if they had heard and listened to what I had. It was real awakening to our naivety as humans, to the beginning, our birth, as not only influencing a single moment in time but an entire existence.

The 'Let Down' and the Beauty of Birth!

My intentions were good... I really wanted to debrief here everyday after work but it seems that baby bundles had other plans for me!! I had made the decision before I started this placement to throw myself into every possible opportunity and that I have. Monday and Tuesday were back-to-back days of 14 hours followed by an awesome encounter with Michel Odent on Wednesday at the BBB Conference backed up with two more days of 'my' midwifery! Below is a little of what happened...

Monday unfolded in a way that had me believing in myself as a midwife. Without really being aware of it at the time, I reflected on the day as awakening me to how much I knew and how far I have come. I had initially started on the ward and had completed my first round and then sat to await the influx of antenatal assessments from clinic. Fortunately for me, with this influx came the opportunity share one woman's experience of nature of birth to creep up at the most unlikely of times.

Whilst she leaned over the desk holding her belly and pointing to her appointment on her handheld record, the adrenaline started pumping. I wasn't quite sure whether to trust what I was suspecting and yet I seemed to go with it sub-consciously. Palpation further confirmed suspicions - LOA, head engaged, uterine tone, concentrated breathing. Baby??

As a formality I continued with the CTG and even with the understanding that their story of the situation isn't always a true indication, I soon had a trace in front of me that flashed 'labour', 'LABOUR', 'LABOUR'!!

Of the many opportunities I have had, it was the first I had been able to step up and take the reins in the sense that I did what I had to do as far as the politics were concerned but also in bring the elements of birth how I know it to assist and optimise this woman's experience. Despite our medicalised surroundings, I kept it simple. We utilised the floor for massage, optimised the calm with minimal light and between contractions, engaged in chit chat. As contractions intensified and second stage neared I followed to the shower that soothed the pain and empowered her with a sense of owning the moment and listening to her body. Close by but far enough away so as not to intrude in 'her' space, I directed the stream of water. When her legs became tired we moved back to the the birthing stool and she found comfort in sitting leaning against her partner whilst I took the weight of her legs on mine to assist in the squat. Position changes flowed to the beginning of second stage and the calm remained.

This mood remained for so long as second stage continued to the point where progress seem to stall despite the numerous position changes and reassurance and a completely happy baby. Given the 'time' restraints and the lingering registrar, it was found we had a case of Deep Transverse Arrest and ventouse birth soon followed.

Tuesday began with another birth and entering the room was so different to the day before. Light, people, urgency. The stage was set and a baby was had. It was beautiful in its own right.

The urgency soon dissipated and I was soon blessed with the opportunity to be with another woman. Although it was an induction, the mood was similar to the day before and I observed as she went about labour as just another part of the day. Ignoring the the syntocinon infusion and the continuous CTG monitoring (which is sometimes hard to do!) she birthed her baby like a goddess. I was fortunate to work with a midwife that was happy to hold the active third stage (query as to whether I can call it a physiological third stage or not due to the synt infusion) and I was supported in my choice to allow the cord to pulsate and the baby's need for the blood more than the blood bottles. Skin-to-skin and left to indulge in each other. Beautiful.

Wednesday - BBB Conference! I need a separate post for this. See here!

Thursday - Continuity! Postnatal care of two of these women to discharge! And showered with thankyous and gifts... I swear they are trying to make me fat - I have enough roses chocolates to feed an army!!

Friday... An absolutely fulfilling end to an amazing week! Again blessed with another birth, not just ANOTHER birth but a very special, unique and empowering experience for all involved. This woman was amazing, her husband was amazing and I was priviledged to be given the joy of being there with them. Circumstances for this woman warranted an epidural but the atmosphere was beautiful.

It was this finish to an unforgettable week that awoke me to my evergrowing intuition and my obvious distrust in it! Silly me... All signs pointed to second stage - palpation, fetal heart heard OA and early decelerations with contractions = head compression. Registrar appears. Outcome of palpation - head felt high! Response - huh? and a quick check. A show and head on view! Two pushes, no gloves, baby born, to chest, finds boob, sucks... no fuss, no rush.

SO I have explained the latter part of the title of this post and have in the best way expressed how I brought my understanding of birth and midwifery to the forefront and advocated and empowered the woman despite what was outside the bubble...

Definitely no 'let down', but plenty of 'let downs'!!! (what birth does to a breastfeeding midwife!) HOW I LOVE OXYTOCIN!!

Thought for today...

I wrote this today in response to another post on our uni discussion board. For some reason it sounded good to me and reflected so much of what I have been feeling in the past two weeks and I wanted to share it...

I don't know how anyone in the position that we are as midwives, could forget how priviledged we are to be a part of the most significant moments in so many families lives. As a mother I can truly say that that single moment in your life when you birth your baby into this world and you become two separate entities, its not only the most beautiful and surreal and amazing experience (for lack of better words!!) but also the most vulnerable, scary and uncertain time because life just takes on this million mile an hour spin and in a solarity moment, your life changes forever. What happens, who is there, the things that are sad, what isn't said and everything else remains imprinted on your life, more than the actual physical act of giving birth because it seems as though we soon forget the pain and the vulnerability that we feel.

To be a part of a woman, a families and a childs experience of entering this world is an honour because not one is ever the same. The circumstances are different, the people are different, the baby is different.

We have to realise how truly priviledged we are to share the beauty of life in its purest form. Its something I cherish and have at the forefront of my mind because without these women and families, I wouldn't be in love with what I do and be completely fulfilled and complete.

I have been showered with gifts and I am only into my second week of placement. I have 3 boxes of roses chocolates from women I have been with and to me, all I did was do what I felt was owed to them. My gift to them for allowing me to be a part of that special time in their lives. I should be the one thanking them, not vice versa.